Substance Use
Addiction, withdrawal, recovery, and the conditions that most often travel with substance use.
Reviewed by Shariq Refai, MD, MBA
Substance use disorders are highly treatable, frequently missed in primary care, and historically separated from mental health care in ways that don't match how the conditions actually interact. This hub exists to bring substance use back into the mental health conversation and to make the medication-assisted treatment options visible.
Substance use disorders are among the most common and most under-treated conditions in mental health. About 30 percent of US adults will meet criteria for a substance use disorder at some point in their lives. About 90 percent of people who could benefit from treatment don't receive it. The treatment gap is driven by stigma, by under-recognition in primary care, and by a long-standing separation between mental health care and addiction care that doesn't reflect how the conditions actually interact.
Inside the category are several distinct conditions: alcohol use disorder, opioid use disorder, stimulant use disorder, cannabis use disorder, sedative use disorder, and substance-induced disorders. Each has its own pharmacology, its own withdrawal profile, and its own evidence-based treatments. The shared feature across the category is the cycle of cravings, use, consequence, and renewed use that the cluster reinforces.
This hub maps the conditions, symptoms, and treatments inside the substance use category. Treatment is well-evidenced. Medication-assisted treatment (MAT), which includes buprenorphine, methadone, naltrexone, and acamprosate, has the strongest evidence for opioid and alcohol use disorders specifically, often combined with behavioral therapy and peer support. The standard of care has shifted meaningfully in the last decade.
Conditions
Alcohol use disorder
What alcohol use disorder actually is under DSM-5-TR, why medication-based treatment works, and what evidence-based recovery looks like.
Strong ConditionOpioid use disorder
What opioid use disorder is, why medications for OUD save lives, and how naloxone and harm reduction fit in.
Strong ConditionCannabis use disorder
What cannabis use disorder is, how high-potency products changed the risk picture, and what evidence-based treatment can offer.
Mixed ConditionGambling disorder
Gambling that keeps going despite serious harm to money, relationships, or health.
Mixed ConditionSubstance use disorder
What substance use disorder is, why it's not a moral failing, how it changes the brain, and what treatment helps.
StrongPlanned coverage (6)
- Stimulant use disorder
- Sedative hypnotic or anxiolytic use disorder
- Tobacco use disorder
- Hallucinogen use disorder
- Inhalant use disorder
- Substance induced disorders
Symptoms
Planned coverage (10)
- Cravings
- Withdrawal
- Tolerance
- Loss of control
- Continued use despite harm
- Neglecting responsibilities
- Time spent on substance use
- Unsuccessful attempts to cut down
- Risky use
- Social problems related to use
Treatments
Planned coverage (17)
- Buprenorphine (Suboxone, Sublocade)
- Methadone
- Naltrexone (oral and Vivitrol)
- Acamprosate
- Disulfiram
- Varenicline (Chantix)
- Nicotine replacement therapy
- Bupropion for smoking cessation
- Motivational interviewing
- Cognitive behavioral therapy for substance use
- Contingency management
- 12 step facilitation therapy
- Medication assisted treatment (MAT)
- Detoxification
- Residential treatment for substance use
- Intensive outpatient program (IOP)
- Partial hospitalization program (PHP)
Glossary
Planned coverage (12)
- Medication assisted treatment (MAT)
- Detoxification
- Withdrawal syndrome
- Tolerance
- Cross tolerance
- Harm reduction
- ASAM criteria
- Naloxone (Narcan)
- Fentanyl test strips
- Dual diagnosis
- Recovery
- Relapse prevention
Treatment Overview
Substance use disorders are highly treatable, and the standard of care has shifted meaningfully in the last fifteen years. For opioid use disorder, the evidence is clear: medication for opioid use disorder (buprenorphine, methadone, or extended release naltrexone) saves lives and improves outcomes. People treated with MOUD have substantially lower rates of overdose death than people treated with detox alone or counseling alone. For alcohol use disorder, naltrexone (oral or the Vivitrol monthly injection), acamprosate, and disulfiram all have FDA approval and clinical evidence; naltrexone and acamprosate work for the largest share of patients. For tobacco use disorder, varenicline plus nicotine replacement therapy plus brief behavioral counseling is the highest evidence combination. Stimulant use disorder and cannabis use disorder don't yet have FDA approved medications, but behavioral approaches (contingency management for stimulant use disorder specifically, motivational interviewing and CBT broadly) have evidence. Co occurring psychiatric conditions (depression, anxiety, PTSD, ADHD) are common in substance use and need to be treated alongside the substance use, not after it. Harm reduction approaches (naloxone access, fentanyl test strips, syringe exchange where legal) save lives even when complete abstinence isn't the immediate goal. AA, NA, and SMART Recovery are free, accessible peer support resources that help many patients alongside clinical treatment.
Resources and Support Organizations
The organizations below are independent of Shrinkopedia and the Shrink Network. We list them because they're recognized national resources, not because we have any financial or organizational relationship with them. Most are free at the point of access.
- SAMHSA National Helpline Free, confidential treatment referral and information service for individuals and families facing substance use disorders, available 24 hours a day in English and Spanish. 1-800-662-4357 (HELP) · samhsa.gov
- Find Treatment (SAMHSA) Federal directory of evidence based substance use treatment providers, searchable by location, insurance, and the specific substances treated. findtreatment.gov
- Alcoholics Anonymous (AA) International peer support fellowship for people with alcohol use disorder. Meetings are free and widely available in person and online. aa.org
- Narcotics Anonymous (NA) Peer support fellowship for people with substance use disorders broadly, modeled on the AA framework. na.org
- SMART Recovery Secular, science based peer support program emphasizing self management and cognitive behavioral tools. Free meetings online and in person. smartrecovery.org
- Faces and Voices of Recovery National advocacy and support organization for people in recovery. Maintains recovery community organization directories. facesandvoicesofrecovery.org
- Al-Anon Family Groups Free support program for families and friends of people with alcohol use disorder. Nar-Anon serves families and friends of people with other substance use disorders. al-anon.org · nar-anon.org
- Shatterproof National nonprofit advocating for evidence based addiction treatment, including standards for treatment quality and policy advocacy. shatterproof.org
- Never Use Alone Hotline Free, confidential service for people who use drugs alone. The line stays on with the caller and dispatches emergency services if the caller becomes unresponsive. 1-877-696-1996
- NAADAC, the Association for Addiction Professionals Professional society for addiction counselors. Maintains a clinician directory. naadac.org
- 988 Suicide and Crisis Lifeline Free, confidential, 24 hours a day in the United States for any mental health crisis. Call or text 988
Substance use most often co-occurs with depression, anxiety, trauma, and ADHD. These adjacent hubs cover the comorbidity.
Across the network
How the network covers this topic.
The Shrink Network covers this topic at multiple layers. Below is a quick map of which site does what for this category. For the full cross-network cluster view, see the matching Network Cluster at /clusters/.
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